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Three Year Cluster Action Plan 2018 - 2021 Penderi Cluster

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Three Year Cluster Action Plan 2018 - 2021 Penderi Cluster Three Year Cluster Action Plan 2018 - 2021 Penderi Cluster 1 | P a g e Welcome to the Penderi Three Year Cluster plan, 2018 – 2021 1. Penderi Cluster Overview The Penderi Cluster Network is one of five clusters in Swansea, geographically covering Blaenymaes, Portmead, Treboeth, Fforestfach, Ravenhill, Brynhyfryd, Manselton, Gendros and Penlan. 2 | P a g e The Penderi Cluster is made up of six general practices working together with partners from key Local Authority Departments such as Social Services and Poverty and Prevention, the Voluntary Sector, Community Pharmacies, Dentists and Optometrists and the wider ABMU Health Board. Practice populations ranging from 2091 to 8334, amounting to a cluster total of 38,122 (July 2018 data). Clusters across the area have agreed that they aim to work together in order to: Prevent ill health enabling people to keep themselves well and independent for as long as possible Develop the range and quality of services t hat are provided in the community Ensure services provided by a wide range of health and social care professionals in the community are better co-ordinated to local needs Improve communication and information sharing between different health, social care and voluntary sector professionals Facilitate closer working between community based and hospital services, ensuring that patients receive a smooth and safe transition from hospital services to community based services and vice versa Through the delivery of their plans they work to meet the Quadruple Aims set out for Health and Social Care Systems in Wales in ‘a Healthier Wales’ (2018): improved population health and wellbeing better quality and more accessible health and social care services higher value health and social care a motivated and sustainable health and social care workforce The Cluster will work collaboratively with Public Health to achieve the outcomes noted in the ‘Burden of Disease’ Action Plan by adopting the five ways of working as outlined in the Wellbeing of Future Generations Act. (Long term, integrated, involving, collaborative, prevention) 2.1. Swansea wide ‘Headline’ Information Population: 242,400. High concentrations of population in and immediately around the City Centre, the adjacent wards of Cwmbwrla and uplands (6,800 people per square km, the highest density in the county) and also in Townhill and Penderi Population has steadily grown between 2001 and 2015. Main driver of population growth in Swansea has been migration. Recorded live births has steadily risen since 2001 and number of deaths have fallen. Life expectancy in Swansea is increasing: Average life expectancy for males is 78 (Wales 78.5) and 82.4 for females (Wales 82.3). This will impact significantly on the provision of health, social care and other public services in Swansea 3 | P a g e Projected population Change: Welsh Government’s latest trend based population projections suggest that Swansea’s population will grow by 9% (21,600 people) between 2014 and 2039 2011 Census suggests that 14,326 people in Swansea were from a non white ethnic group: 6% of the total population and 20,368 (8.5%) of Swansea’s Population were non white British. (above the Wales average (6.8%). Census data (2011) suggests the largest non white ethnic groups are: Chinese 2,052 (0.9%), Bangladeshi 1,944 (0.8%), Other Asian 1,739 (0.7%), Black African 1,707 (0.7%), Arab 1,694 (0.7%) Welsh Language : Proportion of people able to speak Welsh in Swansea decreased from 13.4% (28,938) in 2001 to 11.4% (26,332) in 2011. A fall of 9% despite an increase in population. 2.2 Cluster Specific Information Health and Attainment of Pupils in Primary Education Network (HAPPEN) Established in April 2015, HAPPEN focuses on children in Swansea Schools aged 9-11 years who complete health and wellbeing assessments as part of the Swan Linx Project. Data is collected on body mass index, fitness, nutrition, physical activity, sleep, wellbeing, concentration and children’s recommendations on improving health in their area. Blaenymaes and Portmead schools, (two of the Primary Schools within the Network) have undertaken the study within the last two years, areas of interest are shown below: Blaenymaes % Portmead % Swansea % Sedentary Screen time for 2 hours or more 41% 38% 31% a day 5 Portions of Fruit and Veg a day 17% 24% 27% At least 3 take aways a week 17% 16% 18% Physically active for 1 hr or more a day 24% 14% 24% Happy with family 96% 93% 94% Happy with Life as a whole 94% 81% 91% 2.3 Our Local Health, Social Care and Wellbeing Needs and Priorities 4 | P a g e Information has been collated on a wide range of health needs using the most up to date information available within the Penderi Cluster area in order to support the development of the focus areas for this plan. Key Population Features Cluster Features Population & Community Assets Resident population: 31,900 ( Community Area Profile:Source Mid 2016 rounded estimates ONS) 18 Lower Super Output Areas in the cluster areas. Smallest land 6 GP Surgeries Community Farm located area but highest population density of the cluster areas in Swansea close to Penderi practices. (Community Area Profile) 4 Dental Practices 32.8% of residents are under 24. (Swansea: 31.3%) Parks and Green Spaces 8 pharmacies 8.7 % of residents are 65-74 (Swansea: 10.4%) and 7.5% are 75+ including Blaenymaes multi (Swansea 8.9%) 5 Opticians Use Games Area, Penlan Nearly 50% of patients are living in the 20% most deprived areas Leisure Centre, Ravenhill, 9 Primary schools & 2 Cwmbwrla , Treboeth and (WIMD 2014 revised) Secondary Schools 35.2% of the population live in social rented accommodation from Hafod parks council or RSL/HA). Swansea average is 19.2%. (Swansea 38,122 patients registered- High levels of third Assessment of Local Wellbeing 2017) majority of list sizes increasing sector/external partner Number of people in non white ethnic groups 5.1% .(Swansea High service need for patients involvement in Cluster average 6%) (Swansea Assessment of Local Wellbeing 2017) living in a care home network Highest percentage of lone parents in Swansea 16.7% Swansea specialising in mental health Community Centres (x6) average: 11.7%. (Community Area Profile 2017) and previous drug abuse Libraries (x2) 36.7% of 16-74 year olds are 'economically inactive'. (Swansea: 37%) Two women's refuges within Major employers in the 35.6% of the population aged 16+ have no qualifications . This is the the network (for women and Cluster: City and County of highest level in Swansea. Swansea average is 23.9%. (Swansea children who are victims of Swansea (Schools and Assessment of Local Wellbeing 2017) domestic abuse) depots), First Cymru, Cwmdu 26.3 % of the population have a long term health problem or Industrial Estate, part of disability. This is the highest percentage in Swansea. (average is Swansea West Industrial 23.3%.) (Swansea Assessment of Local Wellbeing 2017) Estate 5 | P a g e Service demands Health Profiles Other Key Influencing High levels of patients who smoke 7,420 , 24.7% of the cluster population (PHW Data 2016/17) Penderi has the second highest Features proportion of patients attending A&E out of all the Swansea Clusters. Average number of lung cancer cases per annum is 32. This is the Between 1st Sep 2017 and 31st Aug Swansea Local Development Plan - highest rate out of the five clusters in Swansea.'Lung cancer 2018, 11,846 patients attended A&E. 3,175 new homes proposed in cluster incidence is higher in the most deprived areas of all ABMs clusters Rate 155.88 per 1000 (ABMU HB data) area with with varying deprivation gaps' (CGP Cluster Lung Cancer Profile ABMU HB Sept 2015) Between September 1st 2017 and 31st Hafod Air Quality Management Action Third highest network for COPD in 2017 956 (6.2%) of patients are August 2018 the attendance rate for Plan declared in Lower Swansea Valley on the disease register. (Swansea average: 5.6%) OoH was 92.18 per 1000 people, the highest rate in Swansea. Uptake for scheduled childhood immunisations by 4 years is 84.5% Public Service Board: Local Wellbeing against the Welsh Government target of 95% Plan Focus; An average of 18.6 patients per month attended the Help Me Quit Service Uptake on Bowel screening 47.4% . Target 60% (PHW offered in practices between April Early Years: Making Sure Children have Data2016/17) 2017 and March 2018. Highest number the best start in Life Uptake on Cervical Screening 75.3% . Target 80% (PHW Data of attendees (30) was in January 2016/17) Live Well. Age Well-Making Swansea a place to live and age well Uptake on AAA screening 75.9%. Target 80%. (PHW Data High levels of low level mental health 2016/17) issues evidenced by Social Presecribing Working with Nature-Improving initiatives including CAB and Primary health,supporting biodiversity and Uptake on Breast screening 71.3%.Target 70% (PHW Data Care Children and Family Wellbeing rediucing our carbon footprint 2016/17) Service and anecdotally by GPs Strong Communities-Supporting Communities to promote pride and Penderi Children and Young People Flu Immunisation Uptake (PHW Data 2017/18): belonging Mental Health consultation identified Patients 65y and over: 66.6% (ABM 68.2%/ Swansea 67.4%) that 75% of respondents needed PSB Aims to make sure all services Patients under 65y at risk 49.9% (ABM 46.7%/Swansea 46.5%) support for mental health issues before work together by sharing resources, Patients under 65y at risk (Respiratory): 52.4% (ABM: 47.2%/ the age of 17, 40% needed support assets and knowledge between 12-16 years and 35% needed Swansea 47.3%) -Wellbeing of Future Generations support under the age of 11 Children aged 2&3 Years 45.6% (ABM 49.1%/Swansea 47.4%) (Wales) Act 6 | P a g e 2.4 Disease Register Information Disease Penderi Register Cluster Trend Swansea % ABMU % Register Total 2018 (%) Cancer 887(2.3%) (2.7%) (2.9%) Practice Variations.
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